by John A. Molinari, PhD
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One of the most troublesome problems faced by health–care professionals (HCP) is the development of hand dermatitis. This condition is called by many terms, including nonspecific irritation dermatitis and irritation contact dermatitis. It is the most common form of harmful skin reaction. The keys to preventing hand dermatitis are to understand how it develops and what factors contribute to its progression.
Most of you perform hand hygiene procedures 20 to 30 times a day either by washing with soaps or antimicrobial antiseptic preparations, or using waterless, alcohol–based hand rubs and sprays. If proper care is not taken, hands can become dry over time, even when using mild liquid soap.
A number of factors can play a role as hands become worse. Keep in mind that healthy intact skin is the primary barrier to prevent infection. Damage to the epithelium can cause changes in the presence of the normal skin microflora. This can result in colonization by “transient” organisms, which typically have a greater potential for causing harmful infections. Methicillin–resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa represent two feared examples of this type of acquired pathogen.
Frequent use of many types of soaps and antiseptics is associated with irritation dermatitis, especially among those HCP who have a history of skin problems. In affected persons, the keratinized epithelium can subsequently become red and sore from acute inflammation. This leads to more drying, even cracking and bleeding. Symptoms usually develop gradually over a period of days to weeks and are localized to the areas of exposure. Most of these adverse manifestations stop at the boundary of the glove cuff with skin.
In addition to frequent washing and use of harsh chemicals, dermal reaction can result from: 1) not completely rinsing antiseptics off skin after washing; 2) irritation from cornstarch powder in gloves; 3) excessive perspiration while wearing gloves; 4) improper washing techniques; 5) using hot water for handwashing; and 6) failure to dry hands completely.
The degree of skin irritation varies considerably and can be reduced substantially by choosing hand hygiene products with emollients, and using appropriate hand lotions that reduce dryness. Antimicrobials in products, such as chlorhexidine gluconate, parachorometaxylenol (PCMX), or iodophors, can also promote treat nonspecific irritation dermatitis. Even alcohols, which are among the safest antiseptics, can cause drying and skin irritation.
Preventing hand dermatitis requires compliance with recommended hand hygiene procedures and routine care of hands. Washing with a handwash agent or waterless product that is the least irritating can help prevent initial drying of skin. Soap should be rinsed off completely after washing and hands should be dried thoroughly.
This becomes even more important when a person has dermatitis. The irritated area is basically a wound, comprised of acute inflammatory cells, dead and dying cells, and epithelial tissue under repair. This site can tend to hold the soap more tenaciously than intact keratinized tissues.
When a person puts on gloves, the hands tend to perspire. This reactivates the bound soap, causing itching and more irritation. The harmful sequence can be short–circuited by using extra effort to rinse and remove the chemical.
Lotions are also routinely recommended to minimize drying from multiple procedures and repeated glove use. Petroleum–based lotions can adversely react with latex gloves by increasing their permeability and making them tacky. Thus, water–based lotions offer a better choice for use during the workday.
You can address the hand dermatitis problem and hopefully even prevent it by instituting an ongoing evaluation of hand care in your practice. This can include answering the following questions:
- Are hand lotions used by HCP to prevent skin dryness associated with hand hygiene?
- Has the compatibility of the available lotion and antiseptic hand hygiene products been considered?
- Has an adverse effect of petroleum–based lotion and other oil emollients on gloves been observed or considered during product selection?
- Are personnel washing with cool or tepid water?
If HCP are using hot water, this can leave skin pores open and hasten removal of skin oils, thereby inducing inflammation and irritation.
Hand hygiene is the single most important infection control procedure you perform. Maximize the total effect by minimizing potentially harmful practices.
Dr. John A. Molinari is director of infection control for THE DENTAL ADVISOR. Previously, he was professor and chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry. Contact him at firstname.lastname@example.org.